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. 2017 Feb;58(2):300-310.
doi: 10.1111/epi.13637. Epub 2017 Jan 23.

The Role of Executive Functioning in Memory Performance in Pediatric Focal Epilepsy

Free PMC article

The Role of Executive Functioning in Memory Performance in Pediatric Focal Epilepsy

Leigh N Sepeta et al. Epilepsia. .
Free PMC article


Objective: Learning and memory are essential for academic success and everyday functioning, but the pattern of memory skills and its relationship to executive functioning in children with focal epilepsy is not fully delineated. We address a gap in the literature by examining the relationship between memory and executive functioning in a pediatric focal epilepsy population.

Methods: Seventy children with focal epilepsy and 70 typically developing children matched on age, intellectual functioning, and gender underwent neuropsychological assessment, including measures of intelligence (Wechsler Abbreviated Scale of Intelligence [WASI]/Differential Ability Scales [DAS]), as well as visual Children's Memory Scale (CMS Dot Locations) and verbal episodic memory (Wide Range Assessment of Memory and Learning [WRAML] Story Memory and California Verbal Learning Test for Children [CVLT-C]). Executive functioning was measured directly (WISC-IV Digit Span Backward; Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-IV) Recalling Sentences) and by parent report (Behavior Rating Inventory of Executive Function [BRIEF]).

Results: Children with focal epilepsy had lower delayed free-recall scores than controls across visual and verbal memory tasks (p = 0.02; partial η2 = 0.12). In contrast, recognition memory performance was similar for patients and controls (p = 0.36; partial η2 = 0.03). Children with focal epilepsy demonstrated difficulties in working memory (p = 0.02; partial η2 = 0.08) and planning/organization (p = 0.02) compared to controls. Working memory predicted 9-19% of the variance in delayed free recall for verbal and visual memory; organization predicted 9-10% of the variance in verbal memory. Patients with both left and right focal epilepsy demonstrated more difficulty on verbal versus visual tasks (p = 0.002). Memory performance did not differ by location of seizure foci (temporal vs. extratemporal, frontal vs. extrafrontal).

Significance: Children with focal epilepsy demonstrated memory ability within age-level expectations, but delayed free recall was inefficient compared to typically developing controls. Memory difficulties were not related to general cognitive impairment or seizure localization. Executive functioning accounted for significant variance in memory performance, suggesting that poor executive control negatively influences memory retrieval.

Keywords: Epilepsy; Executive functioning; Pediatric; Verbal memory; Visual memory.

Conflict of interest statement

of Conflicts of Interest Dr. Sepeta reports grants from American Epilepsy Society, Epilepsy Foundation of America, American Brain Foundation, Children’s National Health System, and NICHD, Dr. Casaletto reports grants from NIDA [F31-DA035708] and the American Foundation for Psychology Benton-Meier Scholarship, Dr. Berl reports grants from NINDS, and Dr. Gaillard reports receiving grant support from NIH, NSF, PCORI, American Epilepsy Society, Epilepsy Foundation, CURE, and Infantile Epilepsy Research Foundation (funded by Lundbeck), sits on the editorial board of Epilepsia, and holds stock with spouse from Pfizer (>$10,000), Siemens (>$10,000), General Electric (>$10,000), and receives funds related to patient care of patients with epilepsy. The remaining authors have no conflicts of interest to report.


Figure 1
Figure 1. Delayed free recall vs. Recognition
Graphs of Delayed Free Recall and Recognition for typically developing controls (blue) and patients with focal epilepsy (green). Z-scores are sample-based for these graphs; dotted lines signify a z-score of 0. CVLT-C, California Verbal Learning Test for Children; CMS, Children’s Memory Scale; WRAML, Wide Range Assessment of Memory and Learning. *Indicates significant difference between groups.
Figure 2
Figure 2. Material Specificity
Graph of verbal and visual delayed free recall for left (blue) and right (green) focal epilepsy. The dotted line signifies a standard z-score of 0. CVLT-C, California Verbal Learning Test for Children; CMS, Children’s Memory Scale. *Indicates significant difference between groups.

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